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    Small Intestinal Bacterial Overgrowth (beta)

    Official guideline of the American College of Gastroenterology.

    Strength
    Conditional recommendation
    Evidence
    Low quality evidence
    Very low quality evidence

    Diagnosis

    Diagnosis
    1. We suggest the use of breath testing (glucose hydrogen or lactulose hydrogen) for the diagnosis of SIBO in patients with IBS.
    2. We suggest using glucose hydrogen or lactulose hydrogen breath tests for the diagnosis of SIBO in symptomatic patients with suspected motility disorders.
    3. We suggest testing for SIBO using glucose hydrogen or lactulose hydrogen breath tests in symptomatic patients (abdominal pain, gas, bloating, and/or diarrhea) with previous luminal abdominal surgery.

    Other Conditions Associated with SIBO

    Other Conditions Associated with SIBO
    1. We suggest against the use of breath testing for the diagnosis of SIBO in asymptomatic patients on PPIs.
    2. We suggest testing for methane using glucose or lactulose breath tests to diagnose the overgrowth of methane-producing organisms (IMO) in symptomatic patients with constipation.

    Treatment

    Treatment
    1. We suggest the use of antibiotics in symptomatic patients with SIBO to eradicate overgrowth and resolve symptoms.
    What do the icons mean?  
    Research PaperPimentel M, Saad RJ, Long MD, Rao SSC. Acg clinical guideline: small intestinal bacterial overgrowth. Am J Gastroenterol. 2020;115(2):165-178.